HIV-associated neurocognitive impairment is unrecognized and untreated in adolescents in most resource-limited regions, such as Botswana. We previously demonstrated that neurocognitive impairment significantly impacts the adult HIV-positive (HIV+) population in Botswana. The principal goal of this proposal is to investigate for the first time the prevalence and nature of HIV-associated neurocognitive impairment among adolescents in Botswana. In addition, we will investigate the association of cognitive impairment with anxiety and depression in adolescents, which we have shown impacts adherence in HIV+ adults in Botswana. This study is designed to measure executive dysfunction in everyday activities and determine if this dysfunction influences high-risk behavior, such as alcohol abuse and sexual behaviors that may contribute to the spread of HIV. The long-term goals of the research include: (1) the development of neurocognitive diagnostic tools and behavior inventories for adolescents living with HIV in Botswana;(2) strengthening the research capacity of the Psychology Department at the University of Botswana through collaborations with US investigators. This will provide the within country Psychology Department with the capability and resources to further apply these tests for clinical and research purposes. Scientific evidence from this research project will provide an important foundation for the development of programs in Botswana to identify and treat adolescents with neurocognitive impairment and other complications of HIV, such as depression and anxiety. This study will provide sufficient experience and data to justify intervention trials for an R01. This is a cross-sectional survey with randomly selected HIV- positive (HIV+) adolescents aged 13 to 18 years, and a demographically matched control group of HIV-negative (HIV-) adolescents in northern Botswana. Research assistants, recent graduates from Department of Psychology at the University of Botswana, will collaborate with data collection, neurocognitive testing, and data analysis/interpretation. Strict quality assurance will be maintained and the psychologists will be specifically trained to administer the tests and will be fluent in the necessary languages (Setswana, Kalanga, and English). All test materials and consent/assent forms will be translated and back translated, and focus groups will review the tests to ensure that they are accurate and sensitive from a cultural perspective. Results of this study will provide data about neurocognitive impairment, anxiety/depression, and high-risk behavior as co-morbid factors of HIV in adolescents in sub-Saharan Africa. This information will enhance earlier detection and intervention for this overlooked population, which will improve outcomes for adolescents with HIV in resource-limited settings. PUBLIC HEALTH RELEVANCE: The goal of this proposal is to investigate the prevalence and nature of HIV-associated neurocognitive impairment among adolescents in Botswana. And to determine the association of cognitive impairment with anxiety/depression, adherence, everyday activities, and high-risk behavior, such as alcohol abuse and sexual behaviors that may contribute to the spread of HIV.